The Functions and Servicesof the Department of Pastoral Care

University of Pennsylvania Health System

1/27/10

A physician calls a chaplain for Ms. Clark, a 68-year-old woman with a recurrence of cancer who has just said, “I don’t understand why this is happening to me; I don’t think I can take it anymore.”

The chaplain visits and listens carefully to the patient as she tells of her struggle with cancer, the recent loss of her mother, her feelings of being overwhelmed, and her life of faith. Honoring her story, the chaplain follows the patient’s lead in thinking about how her life of faith speaks to the meaning of the present crisis.

As Ms. Clark identifies ways that her beliefs and spiritual resources help her to cope, she begins to discern her course ahead with some hope and peace.

Case #1

The Department of Pastoral Care provides spiritual and religious support in a non-sectarian, inter-faith model for patients, family and staff. Chaplains do not proselytize.

Staff chaplains Full and part-time Clinical Pastoral Education students

Fellows Residents Interns Externs

Adjunct Chaplains Volunteer Pastoral Visitors

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Overview

Overview (continued)

At the Hospital of the University of Pennsylvania, a chaplain is available 24/7 for requests and referrals. Chaplains are assigned to each in-patient unit as members of the multi-disciplinary team

At Penn Presbyterian Medical Center, Pennsylvania Hospital, Penn Medicine at Rittenhouse, and Wissahickon Hospice, chaplains are on staff.

Chaplains document their visits in the patients’ medical records at each of these facilities.

Spiritual, Psychosocial, and Cultural Values and Needs

Patients have a fundamental right to considerate care that safeguards their personal dignity and respects their cultural, psychosocial, and spiritual values.

These values often influence patients’ perception of care and illness. Understanding and respecting these values guide the provider in meeting the patients’ care needs and preferences.

The Joint Commission on Accreditation of Health Care Organizations has stated:

The Diversity of Spiritual Values and Religious Expression

People may express their spiritual search for meaning and purpose through an integrated system of religious beliefs and practices.

In the Philadelphia area, there over 3500 different religious congregations representing over 100 different faith traditions. Chaplains are prepared to serve people regardless of their affiliation.

Association of Religion Data Archives, 2000

People may also express their spiritual search for meaning and purpose non-religiously.

1. While many people use the words spirituality and religion interchangeably, they are in fact very different. Spirituality can be defined as a complex and multidimensional part of the human experience—our inner belief system. It helps individuals to search for the meaning and purpose of life, and it helps them experience hope, love, inner peace, comfort, and support.

from "Evaluating Your Spiritual Assessment Process," Joint Commission: The Source [Publication of the Joint Commission on Accreditation of Healthcare Organizations] 3, no. 2 (February 2005): 6-7.

Two Definitions of Spirituality

2. Spirituality is the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.

Puchalski, C., et al., “Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the Census Conference,” Journal of Palliative Medicine 12, no. 10 (October 2009): 885-904

Spiritual, Psychosocial, and Cultural Values and Needs

Harold Koenig, MD, 2001 The Handbook of Religion and Health; Faith and Mental Health; and Spirituality in Patient Care

93% of Americans believe in God or a “higher power.”

89% report affiliation with a religious organization

90% of hospitalized patients rely on religion to cope.

Case #2

Mr. Wilson, a 32-year-old man with Cystic Fibrosis, suffers an episode of acute breathing difficulty. He fears that he may die and asks to receive the Sacrament of the Sick from a Roman Catholic priest.

A chaplain, who is Baptist, responds and makes contact with a priest from the local Catholic church. The chaplain sits with the patient until the priest arrives.

She holds the patient’s hand, provides a non-anxious and caring presence, offers prayers appropriate for this interfaith situation, and helps the patient express his thoughts and feelings with his limited ability to talk. The patient’s panic subsides, and he begins breathing somewhat better.

Four-fold Mission

The mission of the Department of Pastoral Care is to contribute a religious/spiritual dimension to the patient care, research, and education missions of UPHS through:

1) Pastoral care for patients, families, and staff.

2) Pastoral Education and other value-based education offered to clergy, qualified lay persons, and interested hospital personnel and volunteers.

3) Spirituality Research programs undertaken in an interdisciplinary context.

4) Partnerships developed with the surrounding interfaith community to strengthen the wholeness and well- being of our community.

Department Mission Element #1

Pastoral Care for Patients, Families, and Staff

UPHS chaplains provide over 30,000 pastoral care contacts per year.

Chaplains offer: supportive pastoral conversation consultation on treatment decisions, ethical dilemmas, and matters of religious/cultural diversity. religious resources

prayer sacred texts connections to those who would provide sacraments

Department Mission Element #2

Pastoral Education and Other Value-Based Education

Accredited Clinical Pastoral Education programs provide experiential learning for clergy, seminary students and qualified lay persons.

UPHS CPE offers a variety of programs in units of 400-hours each. Over 25 students are involved each year earning a total of more than 12,000 educational hours.

Training for Volunteer Pastoral Visitors, for local denominational groups, and for Penn Med students reaches a wide range of our hospital and community colleagues annually.

Department Mission Element #3

Spirituality Research Medical research indicates the importance of spirituality to patients’ experience of illness and treatment, to the processes of coping, decision-making, and healing, and to physical and mental health outcomes.

Published research by the UPHS Pastoral Care department has been widely quoted in medical literature.

The Annual Spirituality Research Symposium has attracted multi-disciplinary audiences and creative co-sponsors since 1995.

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Department Mission Element #3

Spirituality Research (continued)

Chaplains draw on this growing body of research literature, in addition to religious scholarship, to guide their pastoral care practice.

Clinical Pastoral Education students have monthly seminars to acquaint them with this research, and the monthly Penn Spirituality, Religion and Health Interest Group addresses these topics with inter-disciplinary, multi-institution, community-wide participation.

Department Mission Element #4

Community Partnership

Extensive participation in our accredited ACPE programs, our Volunteer Pastoral Visitor program, and in denominational training programs has built a strong alliance between HUP and the local religious community.

Clinical Pastoral Education programming through the mentoring program at Sayre High School, and a dedicated Trauma Chaplain touch the lives of our youth at risk for

violent injury.

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Department Mission Element #4

Community Partnership (continued)

Seminars for clergy and congregations on a variety of topics engaged in this community network have a major impact on the health of our neighborhoods.

Several denominational groups have established teams and protocols to provide care to their members when hospitalized at HUP.

Pastoral Care with the Penn Trauma Service

Chaplains are designated as the primary liaison between the Penn Trauma Team, the trauma patients and their families.

Chaplains respond to all trauma alerts, 24/7, establishing contact with families on behalf of the team and supporting patients and their families and the staff through immediate crisis intervention.

Our Trauma Chaplain then follows all trauma patients throughout their admission.

Case #3

Mr. Dow, a 21-year-old man, is brought to the emergency department unconscious after being shot. The chaplain on call, a rabbi, arrives to find a large and diverse family: some are Pentecostal, some Muslim, but all are very anxious and upset.

The chaplain hears their questions and concerns, which are primarily for information about their loved one. He works as a liaison between the family and the clinical team. As he develops a relationship with the family, one person says, “Let’s all pray.”

Aware of religious tensions among family members, the rabbi leads a moment of silent prayers. When a physician arrives, the chaplain introduces her, encouraging a sense of trust.

Referrals to

Pastoral Care

Chaplains make regular rounds on all in-patient units and participate in discharge and other patient care rounds.

When hospitalized, patients are invited to identify spiritual needs of meaning and purpose, identify their religious affiliation, request assistance in meeting religious needs (including dietary) or request a chaplain visit.

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Referrals to Pastoral Care

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Staff are encouraged to consider referrals to Pastoral Care for spiritual support for:

Patients and families struggling to cope with the impact of illness and treatment.

Patients and families seeking support in facing difficult diagnoses and prognoses

Patients seeking support in making difficult treatment and related personal decisions

Patients, families and staff weighing difficult ethical and

moral dilemmas continued →

Referrals toPastoral Care

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Patient or family requests for resources from their particular tradition (e.g. Christian sacraments, Sabbath candles, or inspirational literature.)

Patients and families indicating spiritual concerns and showing signs of spiritual distress such as interruption of religious activities, use of explicitly religious language amid suffering, raising questions of life meaning, struggling with loss and grief, and apparent distress of unknown origin.

Spiritual Distress

Through serious illness, our core spiritual values and beliefs may feel threatened. This may be referred to as spiritual distress

People need not identify themselves as religious to experience spiritual distress or benefit from time speaking with a chaplain.

And since spiritual distress creates pain that may not respond to medication, it is important to recognize that, for both religious people and those who are non-religious, it occurs as a symptom to be addressed.

Case #4

A nurse calls Pastoral Care with a referral for Ms. Lake, a 51-year old woman who has said that she is not religious but willing to talk with a chaplain. The patient is distraught after hearing that she must have her leg amputated.

The chaplain visits and explains that religion need not be part of their conversation. They speak of the human experience of what it may be like to lose part of one’s body affecting self-image and social activity, and the patient puts this in the perspective of her past losses and her worries about the future.

She says, “I needed to talk this out with someone who wasn’t going to judge or tell me how to feel or simply assure me that everything will be just fine. I think I can now make it through the night.”

Contacting Pastoral Care

For patient referrals and general information contact the Pastoral Care Department offices:

HUP: (215) 662-2591Pennsylvania Hospital: (215) 829-5993Presbyterian Medical Center: (215) 662-9490

See also UPHS Internet and Intranet home pages (under the “Departments” submenu).

Extensive information about Pastoral Care Services, Programs, and Events as well as articles and resources regarding spirituality and diversity, and links to related sites are available at the Department website at

www.uphs.upenn.edu/pastoral